The efficacy and safety of surgical treatment after neoadjuvant chemotherapy for cT4N+ colon cancer / 中华肿瘤杂志

Objective@#To evaluate the safety and efficacy of surgical treatment after neoadjuvant chemotherapy (NCT) for patients with cT4N+ colon cancer, and to explore whether the indication of NCT for colon cancer can be extended from cT4b to cT4N+ .@*Methods@#The clinical data of 40 patients with cT4N+ colon cancer who underwent neoadjuvant chemotherapy followed by surgical treatment was retrospectively analyzed. The safety of neoadjuvant chemotherapy, surgical complications, R0 resection rate, tumor regression grade and prognosis were evaluated.@*Results@#Of the 40 patients, 23 were male and 17 were female; the median age was 57 years old. All patients were well tolerated with chemotherapy, and only one case (1/40, 2.5%) had grade 3 chemotherapy-related adverse event. They all underwent surgery after chemotherapy, and 95.0% (38/40) achieved microscopically clear resection (R0). Of the 11 patients with cT4b, 54.5% (6/11) had undergone multivisceral resection (MVR). Postoperative pathological results showed that 12 patients had moderate to severe tumor regression, including one(1/40, 2.5%) achieved pathologic complete response (pCR). 29(72.5%) and 22 (55.0%) patients achieved down-staging of tumor T stage and N stage, respectively. The occurrence of surgical complications was 22.5% (9/40), including one case of anastomotic leakage (1/40, 2.5%). The 3-year disease-free survival and overall survival of the whole group were 75.0% and 80.0%, respectively.@*Conclusion@#Surgery after neoadjuvant chemotherapy is safe and effective for patients with cT4N+ colon cancer, therefore indications for neoadjuvant chemotherapy for advanced colon cancer can be extended to cT4N+ stage.

The association of metastasis-related indexes of lymph nodes and the prognosis of stage N2b colorectal cancer patients / 中华肿瘤杂志

Objective@#To evaluate the prognostic value of lymph node metastasis-related indexes in patients with stage N2b colorectal cancer.@*Methods@#Clinicopathologic data of 245 patients with stage N2b colorectal cancer who initially underwent radical operation in Cancer Hospital, Chinese Academy of Medical Sciences between January 2007 and December 2012 were retrospectively analyzed. The prognostic values of several indexes, including number of positive lymph nodes, number of negative lymph nodes, lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) were analyzed.@*Results@#The 5-year overall survival rate of 245 patients with colorectal cancer was 54.0%, and the 5-year recurrence-free survival rate was 48.5%.Univariate analysis showed that perineural or blood vessel invasion, T stage, postoperative adjuvant therapy, number of positive lymph nodes, number of negative lymph nodes, LNR, and LODDS were significantly associated with the 5-year overall survival of colorectal cancer patients (P<0.05). Multivariate cox regression analysis showed that, number of positive lymph nodes, number of negative lymph nodes, LNR, LODDS were all independent prognostic factors for stage N2b colorectal cancer patients (P<0.05). The areas under the receiver operating characteristic curve (ROC) curves of number of positive lymph node, number of negative lymph nodes, LNR and LODDS were 0.649, 0.667, 0.690 and 0.683, respectively, however, no statistical significance was observed between the number of negative lymph nodes (P=0.622), LNR (P=0.178) or LODDS (P=0.272) and the number of positive lymph nodes.@*Conclusion@#The number of positive lymph nodes, number of negative lymph nodes, LNR and LODDS were all independent prognostic factors for patients with stage N2b colorectal cancer.

Surgical management of patients with pathologic complete response in the primary tumor after neoadjuvant chemotherapy for rectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarize and analyze the clinicopathological features and surgical management of patients with pathologic complete response (pCR) in the primary tumor after neoadjuvant chemotherapy for rectal cancer, and to explore the rational treatment of this entity.</p><p><b>METHODS</b>Clinical data of fifty-two patients with locally advanced mid-low rectal cancer admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Sciences from January 1994 to December 2013 were retrospectively analyzed. They were treated with neoadjuvant chemotherapy and achieved pathological complete response in the primary tumor. The preoperative clinical staging were stage II (cT3~4N0) in 10 cases and stage III (cT3~4N+) in 42 cases. After the neoadjuvant therapy, 10 cases achieved clinical complete response (cCR) (19.2%).</p><p><b>RESULTS</b>Radical surgery was performed in 51 patients. Among them, five patients (9.8%) had pathological lymph node metastasis. One cCR patient underwent transanal local excision. The postoperative complication rate was 21.2%. During a median follow-up of 23.6 months, only one patient developed bone metastasis and another one had enlarged mesenteric and retroperitoneal lymph nodes detected by imaging. All the patients were alive by the last follow-up. The 2-year disease-free survival rate was 96.2% and overall survival rate was 100%.</p><p><b>CONCLUSIONS</b>Radical surgery remains the standard therapy for cCR patients with rectal cancer after neoadjuvant chemotherapy. Local excision and "wait and see" should be recommended with great caution and limited to patients who cannot tolerate or refuse radical surgery with a strong demanding for sphincter saving, or applied in clinical trials.</p>

Expression of Ki67 and clinicopathological features in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the relationship between the expression level of Ki67 and clinicopathological features in breast cancer.</p><p><b>METHODS</b>Data of 918 female patients with invasive ductal breast carcinoma treated in the Cancer Hospital, Chinese Academy of Medical Sciences from Jan. to Dec. 2010 were analyzed retrospectively. The correlation of Ki67 expression and other clinicopathological features in the breast cancer was analyzed.</p><p><b>RESULTS</b>Among the 918 cases, the Ki67 index was 0.9% to 95% (mean value 27.8%). Taking the Ki67 index 14% as the boundary to divide the patients into two subgroups, 263 cases (28.6%) were ≤ 14%, and 655 cases (71.4%) were >14%. There were significant differences between the Ki67 expression and age, tumor size, axillary lymph nodes status, histological grade and the expressions of C-erbB-2, estrogen receptor (ER) and progesterone receptor (PR) (P < 0.05 for all). All the Ki67 indexes of Ki67 expression in luminal B (30.44%), HER-2 overexpression (36.77%) and triple negative (47.40%) subtypes were significantly higher than that in the luminal A subtype (21.36%)(P < 0.01). The expression level of Ki67 in triple-negative subtype (47.40%) was significantly higher than that in the non-triple-negative subtype (24.79%)(P < 0.001).</p><p><b>CONCLUSIONS</b>Ki67 index is significantly correlated with the age, tumor TNM stage, axillary lymph node status, histological grading, ER status, PR status and HER-2 status. A high expression level of Ki67 is a poor prognostic factor for breast cancer. The expression level of Ki67 should be detected routinely and it may become a useful prognostic marker in the treatment of breast cancer.</p>

Surgical Treatment for Colorectal Cancer with Obstruction in Elderly Patients / 中国肿瘤临床

Objective: To evaluate the surgical procedures and prognostic factors for colorectal carcinoma in patients aged over 70. Methods: We retrospectively reviewed 31 colorectal cancer patients aged over 70 seen in our hospital between January 1992 and December 2001.Treatment procedures and outcome of these patients were analyzed.Kaplan-Meier method was used for survival analysis and Cox regression analysis was conducted to analyze prognostic factors. Results: The median age of these patients was 74 years.The median follow-up period was 12 months.The postoperative complication rate was 22.6%.The thirty-days mortality was 6.5%.There were 28 cases of tubular adenocarcinoma (well differentiated in 5 cases,moderately differentiated in 16 cases,and poorkly differentiated in 7 cases)and 3 cases of mucinous adenocarcinoma.As to Dukes stage,there were 8 cases of B stage,9 cases of C stge,and 14 cases of D stage.The overall 5-year survival rate was 22.7%.The 5-year survival rate was 44.4%in the radical surgery group and 7.7%in the palliative surgery group.The median survival period of all patients was 12 months.The median survival period was 38 months in the radical surgery group and 9 months in the palliative surgery group.Univariate analysis showed that the predictors for survival were age,co-morbidity,preoperative serum CEA level,preoperative serum albumin concentration,duration of surgery,radical surgery,and cancer stage. Conclusion: Radical resection is a prerequisite for cure of colorectal cancer with obstruction in elderly patients.Age and preoperative serum albumin concentration are independent prognostic indicators.

Hand-assisted laparoscopic surgery in colorectal carcinoma resection: a report of 14 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the application of hand-assisted laparoscopic surgery (HALS) in colorectal carcinoma resection.</p><p><b>METHODS</b>Fourteen patients with colorectal carcinoma underwent resection by HALS.</p><p><b>RESULTS</b>Hand-assisted laparoscopic right hemicolectomy was performed in 6 of 8 ascending colon cancer patients, spending an average of 160 minutes (110 to 220 minutes) for the procedure. The amount of bleeding was 40 approximately 100 ml. Bowel sounds resumed in 36 approximately 72 hours after the operation. The average interval between the operation and patients' discharge was 8 days (7 to 12 days). For 2 patients the surgeons had to resort to laparotomy. All patients received postoperative chemotherapy. Hand-assisted laparoscopic abdominoperineal resection was performed in 5 of 6 patients with lower rectal cancer, with the average duration of 180 minutes (120 to 270 minutes), with bleeding of 40 to 80 ml. Bowel sounds resumed within 24 to 72 hours and the average discharge interval was 14 days (12 to 18 days). The urinary catheter in 6 patients was removed in 7 to 8 days after the operation. All patients with rectal carcinoma received postoperative chemotherapy and radiotherapy. One patient was shifted to laparotomy because of extensive adhesion in the pelvic cavity. Four of 11 patients treated by HALS experienced slight pain in the incision. No other complications were observed in any of the patients. Remote results await further follow-up.</p><p><b>CONCLUSION</b>Hand-assisted laparoscopic surgery in the treatment of colorectal carcinoma, a safe and simple procedure, not only ensures the clearance of tumor, but also reduces operative trauma and hastens recovery.</p>

Diagnosis and management of rectal gastrointestinal stromal tumor in 19 cases / 中国普通外科杂志

Objective To investigate the clinical and pathologic characteristics of rectal gastrointestinal stromal tumor (GIST),and to evaluate the management of rectal GIST. Methods The clinical and pathological data of 19 cases of rectal GIST in recent 19 years were studied retrospectively. Results The diagnosis of 19 cases of rectal GIST were identified by surgery and pathology. Most rectal GISTs were spindle cell type. Immunohistochemical analysis displayed positive reactivity for CD117(100%) and CD34(73. 7% ). Graded by aggressive behavior there were 4 cases of high risk, 3 cases of intermediate risk, 5 cases of low risk and 7 cases of very low risk. Conclusions Rectal GISTs have a low prevalence and have no specific symptom in the early stage. Most tumors are low risk in aggressive behavior. It is difficult to get an accurate pathological diagnosis before operation and difficult to decide whether a sphincter preserving procedure is justified however trans-anal local resection is the therapy of choice for low risk submucosal rectal GIST(